RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-02976
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Infantryman, medically separated for “bilateral patellofemoral syndrome” with a disability rating of 20%.  “Depressive disorder, NOS [not otherwise specified]” was determined to have existed prior to service (EPTS) and was not rated. 

CI CONTENTION:  He continues to have issues with his left knee and mental health conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20090803	VARD – NA 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Patellofemoral Syndrome	5099-5003	20%	No VA Examination Proximate to Separation in Evidence	
Depressive disorder, NOS	9499-9434	EPTS		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA 	

ANALYSIS SUMMARY:  

Bilateral Patellofemoral Syndrome.  According to service treatment record (STR) and MEB narrative summary (NARSUM, the CI underwent a left ACL reconstruction in August 2007 and a revision in September 2008 due to repeated trauma.  Secondary to a prolonged recovery, the CI developed a compensatory patellofemoral pain syndrome in the right knee. 
At the 29 May 2009 MEB NARSUM examination, 6 months prior to separation, the CI’s chief complaint was ”bilateral knee pain.”  The physical examination revealed left knee range of motion (ROM) from 0-120 degrees (normal 0-140) on the left, with pain; and ROM from -5-130 degrees on the right.  The provider noted no instability within either knee joint.  There was no VA examination proximate to separation in evidence. 

The panel directed its attention to its rating recommendation based on the above evidence.  The PEB separately rated each knee condition 10%, analogously coded 5099-5003 (degenerative arthritis), citing evidence of painful motion.  Members first agreed that there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension of the knee joint (5260, 5261).  The left knee clearly revealed impairment and therefore met criteria for minimum 10% rating for painful motion (VASRD §4.59).  The right knee, having only slight limited motion, did support any degree of a positive impairment. Therefore, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the bilateral knee pain condition. 

Depressive Disorder, NOS.  According to the STR and MEB NARSUM, the CI began having behavioral problems throughout his early years of education and was first diagnosed with a mental health (MH) condition at age 10.  Prior to service, incidents included numerous altercations in high school (resulting in expulsion from two separate schools) as well as being arrested for fighting with a school principle at age 15.  Additionally, the CI was placed on numerous psycho-stimulant medications over many years prior to service entry.  Records indicated two separate psychiatric hospitalizations at age 12 (uncertain duration) and a 2-week admission at age 18 for depression and substance abuse.    

While recovering from his bilateral knee condition, the CI was placed into a Warrior Transition Unit (WTU).  At the 28 May 2009 MEB NARSUM psychiatric examination, 6 months prior to separation, he continued to report depressed mood, recent onset of panic attacks, irritability, poor sleep, poor concentration and decreased interest in pleasurable activities since being in the WTU.  The provider noted the CI’s “depressive and anxiety symptoms are worse due to the stress of the WTU and the uncertainty of his future in the Army.  He is eager to leave the military; he feels his mental state will worsen if he is to remain in the military and states he may become suicidal.”  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB determined “Depressive disorder, NOS, in a setting of axis II personality disorder NOS, anti-social and narcissistic traits and a history of alcohol dependence and substance abuse” existed prior to service and was not aggravated by service.  Members agreed that the identified MH condition was neither acquired from, nor adversely affected by, service activities.  The CI’s symptoms were manifestations of his unfavorable acceptance of the WTU activities as well as his uncertainty of continuing military service in conflict with his desire to leave military service.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the depressive disorder condition as EPTS and not permanently service aggravated.     

BOARD FINDINGS:  In the matter of the bilateral knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the depressive disorder condition and IAW VASRD §4.130, the panel recommends no change from the PEB’s EPTS determination without service aggravation.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170403, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008814, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure